The Better Choice In
Women's Home Healthcare

 

 

Healthy Connections Payer Profile

Use this form to submit your information.

Payer Name:
Address:
Contact First Name:
Contact Last Name:
Phone:
Email:
Website
Contracting Personnel:
Medical Director:
O.B. Case Manager:
How many members are in plan?
Number of Deliveries (year/month)?
Does this plan have Medicaid members? Yes No
If yes, how many?
Does this plan have Medicare members? Yes No
If yes, how many?
Do they have contracts that specifically have OB home care services/carve outs? Yes No
Do they currently provide Maternal/Child home care?
 Yes No
Are they experiencing any problems (excessive costs/Niccu) with this program?
 Yes No
If yes, please explain:
Service area where members reside (counties/cities):
Program components and estimated patients on home care service per month?
Preterm Labor Management Gestational Diabetes
Phone Contact Only Diet Mod Only
Home Uterine Monitoring Injection Therapy
Terbutaline Pump Insulin Pump
Pregnancy Induced Hypertension Hyperemesis Therapy
Non Stress Test Hydration Therapy
  Reglan/Zofran Pump
  TPN
Anticoagulant Therapy  
Heparin Injections  
Heparin Pump Therapy  
Nursing Visits Risk Assessment
Post Partum Visits Internal Program
Lactation Consultants Outsourced
All Other  
Details:  
Names of key participating providers who specialize in high-risk patients?
Hospitals  
Name Contact
Name Contact
Name Contact
Perinatoligists  
Provider Number
Provider Number
Provider Number
Home Care Agencies  
Provider Contact
Provider Contact
Provider Contact
What is the strength and weaknesses of the home care providers?
What other services/procedures would you like to see developed for your patients?
Other Comments:  
Click on "Submit" to submit form. Thank you for your interest!